Deprivation and systematic stroke prevention in general practice

Background: To investigate differences in quality of preventive care provided by general practitioners (GPs) to patients at risk of stroke living in deprived and non-deprived neighbourhoods in the Rotterdam region. Methods: A ‘deprivation score’ was used to categorize neighbourhoods according to their deprivation status. Data on the process of patient care were collected by means of chart review and interviews with GPs. Cases of stroke (n=188) were retrospectively audited by an expert panel with guideline-based review criteria. To measure differences in quality of patient care between neighbourhoods, deprivation scores were related to scores for sub-optimal care. Results: After adjustment for socio-demographic characteristics, patients in deprived neighbourhoods had an increased risk (OR 1.95 (95% CI: 0.98–3.90)) of having received sub-optimal preventive care if compared with patients in non-deprived neighbourhoods. This excess risk was limited to women (OR 3.57 (95% CI: 1.39–9.16) vs OR 1.01 (95% CI: 0.41–2.48) in men). Adjustment for socio-demographic characteristics and risk factor distribution did not change the OR for women to receive sub-optimal care significantly (OR 3.21 (95% CI: 1.24–8.31)). Sub-optimal care originated mainly from deficiencies in follow-up of treated hypertensive and diabetes patients and evaluation of patients' cardiovascular risk profile. Among treated hypertensive women in deprived neighbourhoods who received sub-optimal care, the mean number of deficiencies related to follow-up was almost double that of the corresponding group in non-deprived neighbourhoods. Conclusion: Quality of care to prevent stroke in general practice differs considerably between deprived and non-deprived neighbourhoods. Patients in deprived neighbourhoods, and women in particular, have almost twice the risk of receiving sub-optimal preventive care.